Category Archives: Carrier News

Santa Cruz Provider Networks Tighten in 2017 and Kaiser Comes to Santa Cruz

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StethoscopeAccording to Santa Cruz health insurance specialist, Kathleen Brewer de Pozos, more individual subsidized ObamaCare health plans offered by Covered California in Santa Cruz County will be limiting the number of doctors you can choose. The physician networks contracting with each plan may not be finalized until October or November, possibly later. (Blue Shield, for example, did not reach agreement with one of its major providers two years ago until January, two months after the beginning of open enrollment.) Nevertheless, carrier websites continue to offer regularly updated search functions that will assist members in selecting network providers.

Only One PPO for Santa Cruz County

Blue Shield will be the only carrier offering a PPO (Preferred Provider Organization) in Santa Cruz County in 2017. PPOs have bigger networks and fewer controls on getting specialty care. PPO plans will also allow members to go out of network, but they will face higher up-front deductibles for those services and be left with paying the difference between what the PPO will pay and what the out-of-network doctor charges.

Two EPOs for Santa Cruz

Anthem and Health Net are offering EPO (Exclusive Provider Organization) plans for 2017. EPOs are more restrictive and may have smaller networks. Members do not need a referral from their primary care doctor to see a specialist. Because they have smaller networks and don’t pay for any non-emergency services outside of the network, EPO premiums are generally lower than those for PPOs.

Kaiser Comes to Santa Cruz County

The Kaiser Foundation Health Plan will offer its HMO (Health Maintenance Organization) plan to Santa Cruz County residents for the first time in 2017. Many local residents have been lobbying for Kaiser to come to the region for over 25 years. Kaiser almost always contracts with its own doctors, The Permanente Medical Group (TPMG).

HMO plans are sometimes called gate keeper plans because members must have a referral from their primary care provider (PCP) in order to consult with a specialist.

Provider Search Functions Available at Carrier Websites

Watch for physician network information in October and November. This year (2016) Physician’s Medical Group and certain solo practice doctors contracted with Health Net. Dignity Health (Dominican) contracted with Anthem, Blue Shield, and United Healthcare, as well as some other smaller groups and solo practitioners. The Palo Alto Medical Foundation (PAMF) contracted with Blue Shield.

Provider networks change, so be sure to confirm that your doctor(s) are in-network for the plan you select.

Open Enrollment Begins November 1

Open enrollment for new members as well as existing plan members begins November 1 and continues through January 31, 2017. For a plan effective date of January 1, 2017, it is essential to complete an application by December 15, 2016. Start early to avoid the rush! The last few days and hours before each monthly deadline typically get a bit crazy and waits for help are long.

Need Help?

For questions or help anywhere in California call Kathy Brewer de Pozos at: 831-713-6438 or email her at: KathyPozos2000@gmail.com

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Anthem Moves to Protect Members

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digital-binario - ID protection by Marcos TulioAnthem has contracted with AllClear ID, an identity theft and personal identity protection service, to offer identity theft and credit monitoring and repair services to current and former members and employees whose personal information may have been stolen during the recent breach of Anthem databases. To access and sign up for credit monitoring services and/or identity theft repair, visit www.AnthemFacts.com.

Para información en español, haga clic aquí.

Credit monitoring and identity theft repair are offered at no charge to persons affected by the Anthem breach for a 24 month period beginning this month (February 2015). There is no deadline for signing up for this service. Nevertheless, it is easier to fix any breach of personal accounts when the event is detected shortly after it occurs rather than when significant damage has already been done, so early enrollment in this security program is encouraged.

Services offered by AllClear ID include: ID repair, ID theft monitoring, Credit monitoring, Secure Alerts, Lost wallet protection, $1million theft insurance, and Child ID protection. The cost of all of these services will be covered by Anthem.

How do I enroll?

To enroll in the AllClear ID program, visit www.AnthemFacts.com.

When you sign up for the program you will receive a redemption code. That code will be used to set up your personal account. Each person covered by your plan will need a separate account, though all can be monitored by one member of the household. It will be necessary to get a redemption code for each person.

I don’t have internet access. How can I get this service?

If you do not have internet access, call the Anthem response line at: 877-263-7995. Leave your number and we’ll get back to you if you don’t get through immediately.

I got an email from Anthem. Is it legitimate?

Anthem is required by law to send email notifications to any member or employee (past or present) whose personal information may have been breached. Emails from Anthem will not include any live links or requests for any of your personal information. Do not open any link on any email that claims to come from Anthem.

Anthem will also be sending information regarding ID protection by regular mail. Again, do not give information to anyone other than Anthem at 877-263-7995 or through AnthemFacts.com.

What if Anthem calls me?

Regular Anthem calls reminding clients to visit their doctors regularly or get services that are recommended for persons of their age will continue. However, Anthem never asks for personal identity information or member policy numbers during these calls.

Will the ID protection services need to access my computer to fix anything?

AllClear ID will never ask for access to your computer or other electronic device. They will not request personal identification information, passwords, log-in IDs or any other sort of information that could compromise your identity. Report any incident of telephone or computer contact in which someone is doing this at: 877-263-7995.

To get accurate, up-to-date information, visit AnthemFacts.com.

Para información en español, haga clic aquí.

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Anthem’s Personal Info Protection Instructions

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I received this email just now from my Anthem Regional Sales Manager. It has the most recent information you need regarding how to protect your personal information in the wake of the cyber-attack announced this week.

The following is cut and pasted directly from the email:

California residents who have may have been impacted by the cyber-attack against Anthem Blue Cross should be aware of scam email campaigns targeting current and former Anthem members.  These scams, designed to capture personal information (known as “phishing”) are designed to appear as if they are from Anthem and the emails include a “click here” link for credit monitoring.  These emails are NOT from Anthem. 

 DO NOT click on any links in email.

 •             DO NOT reply to the email or reach out to the senders in any way.

•             DO NOT supply any information on the website that may open, if you If you have clicked on a link in email.

•             DO NOT open any attachments that arrive with email.

 Anthem is not calling members regarding the cyber-attack and is not asking for credit card information or social security numbers over the phone.

 This outreach is from scam artists who are trying to trick consumers into sharing personal data. There is no indication that the scam email campaigns are being conducted by those that committed the cyber-attack, or that the information accessed in the attack is being used by the scammers.

 Anthem will contact current and former members via mail delivered by the U.S. Postal Service about the cyber-attack with specific information on how to enroll in credit monitoring. Affected members will receive free credit monitoring and ID protection services.

 For more guidance on recognizing scam email, please visit the FTC Website: http://www.consumer.ftc.gov/articles/0003-phishing.

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Blue Shield / Sutter Health Agreement Reached

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Blue Shield announced today that the company has reached an agreement on a two year extension of its contract with Sutter Health, including the Palo Alto Medical Foundation (PAMF). This agreement, whose terms are not  public, protects both carrier and clients according to Blue Shield.

Sutter Health and the Palo Alto Medical Foundation are major players in the Northern California health care scene. In some  counties, including Santa Cruz, Blue Shield will be the only carrier whose network of providers for individual policies includes Sutter and PAMF, in contrast with 2014 in which these providers contracted with both Health Net and Blue Shield. Patients who had already moved from their Health Net policies to Blue Shield effective January 1, 2015 in order to keep their providers were facing the possibility of having to find new doctors anyway. News of the agreement will be welcomed.

The lack of a contract between Blue Shield and Sutter Health/PAMF affected both individual and group members of the plan.

Open Enrollment for individual and family health insurance continues through February 15, 2015. Contact us today for a free consultation and help enrolling in a plan to meet your needs.

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